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THE THIRD SUFFERING:

Perspectives on disease and disability


from Buddhist canonical literature

URMI CHANDA-VAZ, Masters Program in Ancient Indian History, Culture & Archaeology, Semester II,
Paper: Buddhist Studies, St. Xavier's College, Mumbai, 2015, #31, e: urmi.chanda@gmail.com
INTRODUCTION
Of the four afflictions of life viz. Birth, Old age, Disease and Death, humankind experiences disease
most often. In an increasingly stressful world, the incidence of diseases is higher than ever. Lifestyle,
chronic, genetic, terminal, degenerative, geriatric... the list of diseases is endless. Whether physical or
mental, diseases and disability plague people everywhere. However, these afflictions are not just
modern concerns.
Men of learning from all cultures, across all ages have tried to
find elixirs solutions that will rid man of disease and disability
and help him achieve a long and healthy life, if not immortality.
But these universal truths have remained unchanged.
Watching an ill man was one of the four sights that pushed
Siddharta Gautama toward Buddhahood. Moved by human
suffering, the Buddha went forth to find a way to end it. In the
Pitakas, he offers codes of physical and mental discipline especially to be followed by monks and nuns that would
Bhaiajyaguru or Medicine Buddha
[Image source: www.elisabeththoburn.com]

alleviate bodily suffering. These prescriptions were equally


applicable for the laity and are as effective today as they were
centuries ago.

Speaking of diseases, one must also mention the great physician, Jivaka, who lived during Buddha's
lifetime. He was greatly renowned for his knowledge of Ayurveda and other indigenous systems of
medicine. He personally attended to the Buddha three times a day, and was deemed the chief among
Buddha's lay followers. There are several stories about him and his medical successes. He was also
crowned the 'King of doctors' thrice and is therefore also known as 'Thrice Crowned Physician' 1.
However, it was Buddha's own influence and 'moral genius' on Ayurveda that was remarkable. Clifford
quotes Mitra on this: 'Compassion was the source of his morality and the good of all, the goal of his
moral conduct. Under the moral conducts, the inclusion of celibacy, knowledge, charity, amicableness,
compassion, joy, impartiality and peace in Ayurveda is positively influenced by Buddhism.' 2
In fact, in Pali canonical literature, Buddha has often been portrayed as a great healer. There are
several discourses on illness, care-giving and healing3. In Mahayana Buddhism, this image has been
taken forward where Bodhisattva Bhaiajyaguru or Medicine Buddha is venerated. The Medicine
Buddha is bound by 12 vows to help heal the diseased and deformed. He is an important icon for
physical and mental well-being in Mahayana even in the present day. However, numerous are the
examples of Buddha's healing touch right from the Theravada time.
Health & palliative care and counseling have made considerable progress in the last century, but man's
spiritual needs are barely acknowledged especially when he is afflicted. Cultural exclusion is a major
problem faced by those who suffer from serious chronic ailments or disabilities. This paper aims to
briefly understand the concepts of disease and disability in the context of Buddhist canons, explore
the solutions offered within the canonical framework and how Buddhist philosophy can be relevant,
especially in counseling. The solutions have been long present; we only need to look for them.
On Health
After six years of rigorous ascetic practices, having tormented his body, Buddha had lost all his health
and was at the brink of death. He realised that mortifying the flesh doesn't lead to enlightenment and
1 Terry Clifford, Tibetan Buddhist Medicine and Psychiatry: The Diamond Healing, (Motilal Banarsidass Publ., 1994), p 39
2 Clifford, op. cit., p 39
3 Carl Olson, The Different Paths of Buddhism: A Narrative-Historical Introduction, (Rutgers University Press, 2005), p 101

that it is the mind that had to be mastered. He thereby regained his health and thenceforth preached
its worth. In the 15th chapter of of Sukhavagga in the Dhammapada (Khuddaka Nikaya), it has been
said:
rogyaparam lbh santuhiparama dhana
Visssaparam t nibbaparama sukha.
(Translation: Health is the most precious gain and contentment the greatest wealth. A trustworthy
person is the best kinsman, Nibbana the highest bliss.)
The Buddha understood the value of good health, for only an able body is capable of spiritual
discipline. In the Magandiya Sutta of the Majjhima Nikaya, the Buddha further asserts that 'Freedom
from disease is the foremost good fortune'. It was important for a spiritual sojourner to maintain the
physical body with discipline & moderation, and by avoidance of abuse. In the Buddhist view, health is
a sign of balance of the four elements of earth (pathavi), water (apo), wind (vayo), and fire (tejo) and
disease meant a disturbance in them4.
However, the Buddha also recognises that one can easily become proud of a healthy body and
reminds one to stay humble. For health is but temporary and the human body is subject to disease
and degeneration.
In the Sukhamala Sutta of the Anugattara Nikaya (Sutta Pitaka), the Buddha tells his disciples:
Assutav kho puthujjano attan vydhidhammo samno vydhi anatto, para vydhita disv
ayati, haryati, jigucchati, attnaeva atiyitv171, ahampi khomhi vydhidhammo, vydhi
anatto, aha ceva kho pana vydhidhammo samno vydhi anatto, para vydhita disv
ayeyya haryeyya jiguccheyya, na meta assa patirpanti'. Tassa mayha bhikkhave iti
paisacikkhato yo rogye rogyamado, so sabbaso pahyi. (3.1.4.9)

4 Pinit Ratanakul, Buddhism, Health and Disease, (Eubios Journal of Asian and International Bioethics 15, 2004), pp 162-4

(Translation: Even though I was endowed with such fortune, such total refinement, the thought
occurred to me: 'When an untaught, run-of-the-mill person, himself subject to illness, not beyond
illness, sees another who is ill, he is horrified, humiliated, & disgusted, oblivious to himself that he too
is subject to illness, not beyond illness. And if I who am subject to illness, not beyond illness
were to be horrified, humiliated, & disgusted on seeing another person who is ill, that would not be
fitting for me.' As I noticed this, the healthy person's intoxication with health entirely dropped away.)
In fact, one is encouraged to recognise the body for what it is a collection of organs, orifices and its
many secretions. One of the ten contemplations5 in Buddhism is that on the foulness of the body.
On kinds of diseases
Ancient India of the 6th century BCE was well-versed in the workings of the body. Along with the
development Hindu medicine through Ayurveda, there were Buddhist contributions in the field of
health too. There are two aspects of the Buddhist view of disease. While one is based on the theory of
kamma, the other attributes some diseases to purely physical reasons. In the Girimananda Sutta
(10.60) of the Anguttara Nikaya, Thera Ananda contemplates on the kinds of ailments a human can be
subject to. This passage is clear evidence of the kind of physiological and medical knowledge that was
prevalent at the time.
Bhu dukkho kho aya kyo bahu dnavo, iti imasmi kye vividh bdh uppajjanti, seyyathda:
cakkhurogo sotarogo ghnarogo jivhrogo kyarogo ssarogo kaarogo mukharogo dantarogo kso
sso pinso aho jaro kucchirogo mucch pakkhandik sl viscik kuha gao kilso soso
apamro dadd kau kacchu rakhas vitacchik lohitapitta madhumeho as piak bhagandal
pittasamuhn bdh semhasamuhn bdh, vtasamuhn bdh sanniptik bdh
utuparimaj bdh visamaparihraj bdh opakkamik bdh kammavipkaj bdh sta
uha jighacch pips uccro passvo''ti. Iti imasmi kye dnavnupass viharati. Aya
vuccatnanda dnavasa.
(Translation: Many are the sufferings, many are the disadvantages (dangers) of this body since
diverse diseases are engendered in this body, such as the following: Eye-disease, ear-disease, nose5 Anugattara Nikaya, Girimananda Sutta, 10.60

disease, tongue-disease, body-disease, headache, mumps, mouth-disease, tooth-ache, cough, asthma,


catarrh, heart-burn, fever, stomach ailment, fainting, dysentery, swelling, gripes, leprosy, boils,
scrofula, consumption, epilepsy, ringworm, itch, eruption, pustule, plethora, diabetes, piles, cancer,
fistula, and diseases originating from bile, from phlegm, from wind, from conflict of the humors, from
changes of weather, from adverse condition (faulty deportment), from devices (practiced by others),
from kamma-vipaka (results of kamma); and cold, heat, hunger, thirst, excrement, and urine.)
Causes of disease
Apart from attributing some diseases to kamma, the Buddha also enumerated the physical causes for
some illnesses. In the Sivaka Sutta of the Samyutta Nikaya 36.21 (Sutta Pitaka), Buddha clearly tells
Moliyasivaka that some ailments of the body are caused by factors such as bile, phlegm, internal
winds, a combination of bodily humors, from the change of the seasons, from uneven care of the
body, and from harsh treatment.
As he does in the case of physical ailments, Buddha also enlists a number of causes of mental
ailments. The mind is of supreme importance in Buddhist thought. Ideals of mental health and
parameters of mental disease are consequently well defined. It wouldn't be exaggeration to say that
Buddhist psychology is at par with modern developments in the science, if not better. Vipallasas or
perversions of the mind are briefly described in the Vipallasa Sutta of the Anguttara Nikaya 4.49
(Sutta Pitaka).
Anicce niccasaino dukkhe ca sukhasaino,
Anattani ca attti asubhe subhasaino.
Micchdihigat satt khittacitt visaino,
Te yogayutt mrassa ayogakkhemino jan.
Translation: Sensing no change in the changing, Sensing pleasure in suffering, Assuming self where
there's no self, Sensing the un-lovely as lovely Gone astray with wrong views, beings mis-perceive
with distorted minds.)

This passage condenses many fundamental teachings of Buddhism like non-self and constant change.
But the principle of Kamma is central to understanding illness both mental and physical from a
Buddhist perspective.
Kamma and disease
Kamma is a principle of interconnectedness that sees individuals and society as a cohesive whole. As
mentioned above, kamma-vipaka is considered among the many reasons that cause a person to be ill.
Further, Buddha expostulates in the Tamonata Sutta of the Anguttara Nikaya 4.85 (Sutta Pitaka),
that certain kinds of people are born into darkness as a result of their past deeds. This causes them to
be 'born into a lowly family the family of a scavenger, a hunter, a basket-weaver, a wheelwright, or a
sweeper a family that is poor, with little food or drink, living in hardship, where food & clothing are
hard to come by. And he is ugly, misshapen, stunted, & sickly: half-blind or deformed or lame or
crippled. He doesn't receive any [gifts of] food, drink, clothing, or vehicles; garlands, perfumes, or
ointments; bedding, shelter, or lamps. He engages in bodily misconduct, verbal misconduct, & mental
misconduct. Having engaged in bodily misconduct, verbal misconduct, & mental misconduct, he on
the break-up of the body, after death reappears in the plane of deprivation...'.
But that does not consign man to an eternally hopeless life. All men even those born with bodily
deformities or congenital diseases can hope to journey from a life of darkness to a life of light. Good
physical, verbal and mental conduct will elevate a person on a spiritual platform, says Buddha 6.
Patient care and counseling
Like all other questions about life, disease is also treated very practically. Since disease, decay and
death are inevitable, they must be dealt with pragmatism. The Buddha offers great insights into
patient psychology and lists the types. He mentions what kind of patients are amenable to care and
the kind that are difficult to treat. He takes a step further and even talks about the right (and wrong)
kinds of nurses and caregivers!

6 Sutta Pitaka, Anugattara Nikaya, Tamonata Sutta, 4.85

The Kucchivikara-vatthu of Mahavagga 8.26.1-8 (Vinaya Pitaka) deals with these categories of
patients and caregivers. This section also underlines the importance of serving others in Buddhist
ideology. An episode from Buddha's life demonstrates his supremely compassionate nature. He once
came across an old monk who was terribly ill. Suffering from acute dysentery, the monk lay in a
pitiable condition in his own filth. None of the monks of the monastery helped him as he was not
known to help anyone. But the Buddha, along with his foremost disciple, Ananda, cleaned up the ill
monk, thereby setting an example of selfless service. He proclaimed that Whoever would tend to me,
should tend to the sick, and decreed that the monks, who have only each other, should practice
brotherhood and care.
The virtue of acceptance is also propounded in Buddhism. Often, those plagued by chronic, terminal
or genetic illnesses find it hard to accept their fate. The Why me? question often arises and there
are no easy answers. Caregivers of perennially ill people also experience massive amounts of stress
and are often in need of as much counseling as the patients themselves. The Sukhamala Sutta of the
Anguttara Nikaya says that even when in the pink of health, one should remember that our bodies are
equally vulnerable. When one begins to lack empathy, it is good to remind ourselves that tomorrow
we could be on the sickbed instead of the caregiver's shoes.
Pragmatic acceptance of disease and disability is what needs to be practiced, according to Buddha.
The stress of not getting what is wanted a perfect body and health in this case is expounded in the
Saccavibhanga Sutta of Majjhima Nikaya - 3.4.11 (Sutta Pitaka). Objectivity is another powerful tool
to help cope with illness, the canons say. The Gilana Sutta of Samyutta Nikaya 8.1.10 (Sutta Pitaka),
gives us a story about Thera Anuruddha, who was once severely ill. Despite his grave sickness he
seemed composed and when the other monks asked him how he could be so calm, he said:
Catusu kho me vuso, satipahnesu spahitacittassa viharato uppann srrik dukkh vedan
citta na pariydya tihanti. Katamesu catusu: idhha vuso, kye kynupass viharmi tp
sampajno satim vineyya loke abhijjhdomanassa. Vedansu vedannupass viharmi tp
sampajno satim vineyya loke abhijjhdomanassa. Citte cittnupass viharmi tp sampajno
satim vineyya loke abhijjhdomanassa. Dhammesu dhammnupass viharmi tp sampajno
satim vineyya loke abhijjhdomanassa. Imesu kho me vuso, catusu satipahnesu

spahitacittassa viharato uppann srrik dukkh vedan citta na pariydya tihantti.


(Translation: When I dwell with my mind well-established in the four frames of reference, the pains
that have arisen in the body do not invade or remain in the mind. Which four? There is the case where
I remain focused on the body in & of itself ardent, alert, & mindful putting aside greed & distress
with reference to the world. I remain focused on feelings in & of themselves... mind in & of itself...
mental qualities in & of themselves ardent, alert, & mindful putting aside greed & distress with
reference to the world. When I dwell with my mind well-established in these four frames of reference,
the pains that have arisen in the body do not invade or remain in the mind.)
Conclusion
Meditation and gaining control over one's mind have been accorded the highest importance in
Buddhist teachings. Sustained observance of the 8-fold path not only leads to eventual liberation, but
also eases the journey of life. Fraught with disease, disability and decay, the human body is a vehicle
of dukkha. But alleviating physical & mental pain and ensuring health is desirable and even necessary.
Buddhism's practical approach towards illness and care is significant and applicable even in the 21 st
century and can offer great solace and comfort to millions who are suffering. It's time to turn to the
ever-new ancient answers.